Baş Boyun Bölgesine Radyoterapi Uygulanan Hodgkin Lenfoma ve Santral Sinir Sistemi Tümörlü Çocuklarda Tiroid Fonksiyonları ve Tiroid Lezyonları
Abstract
Amaç: Bu çalışmanın amacı Hodgkin lenfoma (HL) veya merkezi sinir sistemi (SSS) tümörlü çocuklarda baş ve boyun bölgesine uygulanan radyoterapi sonrası tiroid fonksiyonunu ve lezyonları değerlendirmektir.
Gereç ve Yöntemler: Çalışmaya HL veya SSS tümörü tanısı alan, kemoterapi (KT) ve baş boyun bölgesine radyoterapi (RT) tamamlanmasından en az bir yıl sonra tam remisyonda olan çocuklar dahil edildi. Tüm hastalardan tiroid fonksiyon testleri ve tiroid ultrasonografisi (USG) istendi.
Bulgular: Çalışmaya toplam 37 hasta dahil edildi. Yaş ortalaması 13.7±3.8’di. Ortalama takip süresi 5.09±2.5 yıldı. Tüm hastalarda BT ve RT mevcuttu. Yedi (%18.9) hastada subklinik hipotiroidi, 7 (%18.9) hastada tiroid USG anormalliği mevcuttu. Hastaların hiçbirinde tiroid malignitesi yoktu. Tanı anında 10 yaşın altında olmak, takip süresinin 3 yıl ve üzerinde olması, RT dozunun 25 Gy veya daha fazla olması subklinik hipotiroidizm gelişimi için etkili faktörler olarak bulundu. Sadece RT dozu 25 Gy veya daha fazlasının tiroid USG anormallikleri ile ilişkili olduğu saptandı.
Sonuç: Kanser tedavisi almış her hastada tiroid fonksiyon bozukluğunu değerlendirmek için klinik bulgulara bakılmaksızın tiroid fonksiyon testleri ve tiroid görüntülemesi rutin olarak incelenmeli ve bu hastaların takipleri ömür boyu yapılmalıdır.
References
- Zahnreich S, Schmidberger H. Childhood Cancer: Occurrence, Treatment and Risk of Second Primary Malignancies. Cancers 2021;13:2607.
- Arain A, Herman T, Matthiesen C. Late Effects of Radiation Therapy in Pediatric Cancer Survivors. J Okla State Med Assoc 2015;108:129–35.
- de Vathaire F, Haddy N, Allodji RS, Hawkins M, Guibout C, El-Fayech C, et al. Thyroid Radiation Dose and Other Risk Factors of Thyroid Carcinoma Following Childhood Cancer. J Clin Endocrinol Metab 2015;100:4282–90.
- Rai G, Kumar A, Mahobiya P. The effect of radiation on thyroid gland. BMC Endocr Disord 2018;3:217-22.
- Lin CL, Wu SY, Huang WT, Feng YH, Yiu CY, Chiang WF, et al. Subsequent thyroid disorders associated with treatment strategy in head and neck cancer patients: a nationwide cohort study. BMC Cancer 2019;19:461.
- Chow JCH, Cheung KM, Cheung GTC, Tam AHP, Lui JCF, Lee FKH, et al. Dose-volume predictors of post-radiation primary hypothyroidism in head and neck cancer: A systematic review. Clin Transl Radiat Oncol 2022;33:83-92.
- Zhou L, Chen J, Tao CJ, Chen M, Yu ZH, Chen YY. Research progress of radiation-induced hypothyroidism in head and neck cancer. J Cancer 2021;12:451-9.
- Duarte V, Maciel J, Cavaco D, Donato S, Damasio I, Pinheiro S, et al. Predictive factors for thyroid complications after radiation therapy-data from a cohort of cancer patients closely followed since they were irradiated. Clin Endocrinol (Oxf) 2022;96:728-33.
- Hancock SL, Cox RS, McDougall IR. Thyroid diseases after treatment of Hodgkin’s disease. N Engl J Med 1991;325: 599-605.
- Demirkaya M, Sevinir B, Saglam H, Ozkan L, Akac O. Thyroid Functions in Long-Term Survivors of Pediatric Hodgkin’s Lymphoma Treated with Chemotherapy and Radiotherapy. J Clin Res Ped Endo 2011;3: 89-94.
- Çağlar AA, Oğuz A, Pınarlı FG, Karadeniz C, Okur A, Bideci A, et al. Thyroid abnormalities in survivors of childhood cancer. J Clin Res Pediatr Endocrinol 2014;6:144-51.
- Eltan M, Akıcı F, Aydoğan G, Şalcıoğlu Z, Er A, Önal H et al. Evaluation of Thyroid Functions in Patients Treated Pediatric Hodgkin Lymphoma. Journal of Child 2019: 124–31.
- Steven G. Waguespack; Thyroid Sequelae of Pediatric Cancer Therapy. Horm Res Paediatr 2019; 91:104–17.
- Lee HJ, Hahn SM, Jin SL, Shin YJ, Kim SH, Lee YS, et al. Subclinical Hypothyroidism in Childhood Cancer Survivors. Yonsei Med J 2016;57:915-22.
- Srikantia N, Rishi KS, Janaki MG, Bilimagga RS, Ponni A, Rajeev AG, et al. How common is hypothyroidism after external radiotherapy to neck in head and neck cancer patients?. Indian J Med Paediatr Oncol 2011;32:143-8.
- Paulino AC. Hypothyroidism in children with medulloblastoma: a comparison of 3600 and 2340 cGy craniospinal radiotherapy. Int J Radiat Oncol Biol Phys 2002;53: 543-547.
- Jin SY, Choi JY, Park KD, Kang HJ, Shin HY, Phi JH, et al. Thyroid dysfunction in patients with childhood-onset medulloblastoma or primitive neuroectodermal tumor. Ann Pediatr Endocrinol Metab 2018;23:88-93.
- Louis DN, Ohgaki H, Wiestler OD. Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumors of the central nervous system. Acta Neuropathol 2007;114: 97-109.
- Milano MT, Vargo JA, Yorke ED,Ronckers CM, Kremer LC, Chafe SMJ, et al. Primary Hypothyroidism in Childhood Cancer Survivors Treated With Radiation Therapy: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2021;17: S0360-3016(21)00128-0.
- Laughton SJ, Merchant TE, Sklar CA, Kun LE, Fouladi M, Broniscer A, et al. Endocrine outcomes for children with embryonal brain tumors after risk-adapted craniospinal and conformal primary-site irradiation and high-dose chemotherapy with stem-cell rescue on the SJMB-96 trial. J Clin Oncol 2008;26: 1112-8.
- Iglesias ML, Schmidt A, Ghuzlan AA et al. Radiation exposure and thyroid cancer: a review. Arch Endocrinol Metab 2017;61:180-7.
- Crom DB, Kaste SC, Tubergen DG, Greenwald CA, Sharp GB, Hudson MM. Ultrasonography for thyroid screening after head and neck irradiation in childhood cancer survivors. J Med Paediatr Oncol 1997;28:15-21.
- Somerville HM, Steinbeck KS, Stevens G, Delbridge LW, Lam AH, Stevens MM. Thyroid neoplasia following irradiation in adolescent and young adult survivors of childhood cancer. MJA 2002;176: 584-7.
- Krawczuk- Rybak M, Kuzmicz M, Goscik E. Investigations of thyroid function in children and adolescents after treatment of Hodgkin’s disease. Med Wieku Rozwoj 2001;5: 43-50.
- Baran JA, Halada S, Bauer AJ, Li Y, Isaza A, Patel T, et al. Thyroid Ultrasound Screening in Childhood Cancer Survivors following Radiotherapy. Horm Res Paediatr 2023;18:1-11.
Thyroid Functionsand Thyroid Lesions in Children with Hodgkin Lymphoma and Central Nervous System Tumors Who Received Radiotherapy to the Head and Neck Region
Abstract
Objective: The aim of this study was to assess thyroid function and lesions after radiotherapy to the head and neck region in children with Hodgkin lymphoma (HL) or central nervous system (CNS) tumors.
Material and Methods: The study included children diagnosed with HL or CNS tumors who were in complete remission at least one year after completion of chemotherapy (CT) and who had all received radiotherapy (RT) to the head and/or neck. All patients were requested to undergo thyroid function tests and thyroid ultrasonography (USG).
Results: A total of 37 patients were included. The mean age was 13.7±3.8 years. The mean follow-up time was 5.09±2.5 years. All patients had CT and RT. Seven (18.9%) patients had subclinical hypothyroidism, and 7 (18.9%) had thyroid USG abnormalities. None of the patients had thyroid malignancy. Age under 10 years at diagnosis, follow-up time of 3 years or more, and an RT dose of 25 Gy or more were found as effective factors for subclinical hypothyroidism development. Only an RT dose of 25 Gy or more was found to be related to thyroid USG abnormalities.
Conclusion: Thyroid function tests and thyroid imaging should be routinely examined in any patient who has been treated for cancer to evaluate thyroid dysfunction regardless of clinical findings and the follow-up of these patients should be lifelong.
References
- Zahnreich S, Schmidberger H. Childhood Cancer: Occurrence, Treatment and Risk of Second Primary Malignancies. Cancers 2021;13:2607.
- Arain A, Herman T, Matthiesen C. Late Effects of Radiation Therapy in Pediatric Cancer Survivors. J Okla State Med Assoc 2015;108:129–35.
- de Vathaire F, Haddy N, Allodji RS, Hawkins M, Guibout C, El-Fayech C, et al. Thyroid Radiation Dose and Other Risk Factors of Thyroid Carcinoma Following Childhood Cancer. J Clin Endocrinol Metab 2015;100:4282–90.
- Rai G, Kumar A, Mahobiya P. The effect of radiation on thyroid gland. BMC Endocr Disord 2018;3:217-22.
- Lin CL, Wu SY, Huang WT, Feng YH, Yiu CY, Chiang WF, et al. Subsequent thyroid disorders associated with treatment strategy in head and neck cancer patients: a nationwide cohort study. BMC Cancer 2019;19:461.
- Chow JCH, Cheung KM, Cheung GTC, Tam AHP, Lui JCF, Lee FKH, et al. Dose-volume predictors of post-radiation primary hypothyroidism in head and neck cancer: A systematic review. Clin Transl Radiat Oncol 2022;33:83-92.
- Zhou L, Chen J, Tao CJ, Chen M, Yu ZH, Chen YY. Research progress of radiation-induced hypothyroidism in head and neck cancer. J Cancer 2021;12:451-9.
- Duarte V, Maciel J, Cavaco D, Donato S, Damasio I, Pinheiro S, et al. Predictive factors for thyroid complications after radiation therapy-data from a cohort of cancer patients closely followed since they were irradiated. Clin Endocrinol (Oxf) 2022;96:728-33.
- Hancock SL, Cox RS, McDougall IR. Thyroid diseases after treatment of Hodgkin’s disease. N Engl J Med 1991;325: 599-605.
- Demirkaya M, Sevinir B, Saglam H, Ozkan L, Akac O. Thyroid Functions in Long-Term Survivors of Pediatric Hodgkin’s Lymphoma Treated with Chemotherapy and Radiotherapy. J Clin Res Ped Endo 2011;3: 89-94.
- Çağlar AA, Oğuz A, Pınarlı FG, Karadeniz C, Okur A, Bideci A, et al. Thyroid abnormalities in survivors of childhood cancer. J Clin Res Pediatr Endocrinol 2014;6:144-51.
- Eltan M, Akıcı F, Aydoğan G, Şalcıoğlu Z, Er A, Önal H et al. Evaluation of Thyroid Functions in Patients Treated Pediatric Hodgkin Lymphoma. Journal of Child 2019: 124–31.
- Steven G. Waguespack; Thyroid Sequelae of Pediatric Cancer Therapy. Horm Res Paediatr 2019; 91:104–17.
- Lee HJ, Hahn SM, Jin SL, Shin YJ, Kim SH, Lee YS, et al. Subclinical Hypothyroidism in Childhood Cancer Survivors. Yonsei Med J 2016;57:915-22.
- Srikantia N, Rishi KS, Janaki MG, Bilimagga RS, Ponni A, Rajeev AG, et al. How common is hypothyroidism after external radiotherapy to neck in head and neck cancer patients?. Indian J Med Paediatr Oncol 2011;32:143-8.
- Paulino AC. Hypothyroidism in children with medulloblastoma: a comparison of 3600 and 2340 cGy craniospinal radiotherapy. Int J Radiat Oncol Biol Phys 2002;53: 543-547.
- Jin SY, Choi JY, Park KD, Kang HJ, Shin HY, Phi JH, et al. Thyroid dysfunction in patients with childhood-onset medulloblastoma or primitive neuroectodermal tumor. Ann Pediatr Endocrinol Metab 2018;23:88-93.
- Louis DN, Ohgaki H, Wiestler OD. Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumors of the central nervous system. Acta Neuropathol 2007;114: 97-109.
- Milano MT, Vargo JA, Yorke ED,Ronckers CM, Kremer LC, Chafe SMJ, et al. Primary Hypothyroidism in Childhood Cancer Survivors Treated With Radiation Therapy: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2021;17: S0360-3016(21)00128-0.
- Laughton SJ, Merchant TE, Sklar CA, Kun LE, Fouladi M, Broniscer A, et al. Endocrine outcomes for children with embryonal brain tumors after risk-adapted craniospinal and conformal primary-site irradiation and high-dose chemotherapy with stem-cell rescue on the SJMB-96 trial. J Clin Oncol 2008;26: 1112-8.
- Iglesias ML, Schmidt A, Ghuzlan AA et al. Radiation exposure and thyroid cancer: a review. Arch Endocrinol Metab 2017;61:180-7.
- Crom DB, Kaste SC, Tubergen DG, Greenwald CA, Sharp GB, Hudson MM. Ultrasonography for thyroid screening after head and neck irradiation in childhood cancer survivors. J Med Paediatr Oncol 1997;28:15-21.
- Somerville HM, Steinbeck KS, Stevens G, Delbridge LW, Lam AH, Stevens MM. Thyroid neoplasia following irradiation in adolescent and young adult survivors of childhood cancer. MJA 2002;176: 584-7.
- Krawczuk- Rybak M, Kuzmicz M, Goscik E. Investigations of thyroid function in children and adolescents after treatment of Hodgkin’s disease. Med Wieku Rozwoj 2001;5: 43-50.
- Baran JA, Halada S, Bauer AJ, Li Y, Isaza A, Patel T, et al. Thyroid Ultrasound Screening in Childhood Cancer Survivors following Radiotherapy. Horm Res Paediatr 2023;18:1-11.
Details
| Primary Language | English |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | ORIGINAL ARTICLES |
| Authors | |
| Early Pub Date | April 25, 2024 |
| Publication Date | |
| Submission Date | January 17, 2024 |
| Acceptance Date | March 14, 2024 |
| Published in Issue | Year 2024 Articles Online First |
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